title: Commentary on "The value of transurethral bladder biopsy after intravesical bacillus Calmette-Guérin instillation therapy for nonmuscle invasive bladder cancer: a retrospective, single center study and cumulative analysis of the literature." Swietek N, Waldert M, Rom M, Schatzl G, Wiener HG, Susani M, Klatte T. Department of Urology, Medical University of Vienna, Vienna, Austria: J Urol 2012;188(3):748-53 [Epub 2012 Jul 20].
abstract: OBJECTIVE
  We evaluated the need of routine transurethral biopsies after an induction course of intravesical bacillus Calmette-Guérin for high grade nonmuscle invasive bladder cancer.
  
  
  METHODS
  This retrospective study included 180 patients with high grade nonmuscle invasive bladder cancer who underwent a 6-week induction course of bacillus Calmette-Guérin. Cystoscopic findings, urinary cytology and pathological results of transurethral biopsy were evaluated. For cumulative meta-analysis we systematically reviewed studies indexed in MEDLINE(®), EMBASE(®) and Web of Science(®). The records of 740 patients from a total of 7 studies were finally analyzed.
  
  
  RESULTS
  Biopsy was positive in 58 patients (32%). Cystoscopy appeared normal in 75 patients (42%) and showed only erythema in 51 (28%) and tumor in 54 (30%), of whom 6 (8%), 11 (22%) and 41 (76%), respectively, showed positive findings at biopsy. The positive predictive value of erythema was 15% with negative cytology and 56% with positive cytology. The positive predictive value of a tumor with negative and positive cytology was 63% and 89%, respectively. A combination of negative cytology and normal cystoscopy was associated with a negative biopsy in 94% of cases. A total of 970 bladder biopsies were taken, of which 137 (14%) were positive, including 20 of 125 erythematous lesions (16%), 73 of 107 tumors (68%) and 44 of 738 normal-appearing areas (6%). Cumulative analysis findings were comparable.
  
  
  CONCLUSIONS
  Routine transurethral bladder biopsies after a bacillus Calmette-Guérin induction course are not necessary. An individually approach is recommended, tailored from cystoscopic findings and cytology.
authors.forename: William A
authors.initials: WA
authors.lastname: See
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D001500:BCG Vaccine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine